Effectiveness of nasotracheal intubation in anterior cervical surgery including C3 lesions.

OBJECTIVE: Anterior approach cervical surgery is widely used for accessing C3 lesions. When operating with an anterior approach, the surgical field is obstructed by mandible. Neck extension is popular method to secure better surgical field but risk devastating neurological damage. To overcome this limited surgical field without neck extension, we adopted nasotracheal intubation and evaluated its efficiency. METHODS: We retrospectively analyzed 16 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via nasotracheal intubation. We enrolled an additional 29 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via orotracheal intubation as a control group. All patients had been diagnosed with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. We measured the mandibular-cervical angle, which is the angle between the lower mandibular line and anterior vertebral line. RESULTS: The mandibular-cervical angle was increased by 7.3 with nasotracheal intubation compared to orotracheal intubation. CONCLUSIONS: Nasotracheal intubation is an effective surgical option for securing the surgical field without neck extension in anterior cervical surgery including C3 lesions.

Gender differences in adult traumatic brain injury according to the Glasgow coma scale: A multicenter descriptive study.

PURPOSE: Patients' gender, which can be one of the most important determinants of traumatic brain injury (TBI) outcomes, is also likely to interact with many other outcome variables of TBI. This multicenter descriptive study investigated gender differences in epidemiological, clinical, treatment, mortality, and variable characteristics in adult TBI patients. METHODS: The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1, 2016 and December 31, 2018. A total of 4468 adult TBI patients were enrolled at eight University Hospitals. Based on the list of enrolled patients, the medical records of the patients were reviewed and they were registered online at each hospital. The registered patients were classified into three groups according to the Glasgow coma scale (GCS) score: mild (13-15), moderate (9-12), and severe (3-8), and the differences between men and women in each group were investigated. The risk factors of moderated and severe TBI compared to mild TBI were also investigated. RESULTS: The study included 3075 men and 1393 women and the proportion of total males was 68.8%. Among all the TBI patients, there were significant differences between men and women in age, past history, and GCS score. While the mild and severe TBI groups showed significant differences in age, past history, and clinical symptoms, the moderate TBI group showed significant differences in age, past history, cause of justice, and diagnosis. CONCLUSION: To the best of our knowledge, this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea. This study shows significant differences between men and women in many aspects of adult TBI. Therefore, gender differences should be strongly considered in TBI studies.

Efficacy of automated percutaneous lumbar discectomy for lumbar disc herniation in young male soldiers.

Lumbar disc herniation (LDH) often results in back pain and radicular pain and is frequently treated with minimally invasive non-surgical methods in Korean Armed Forces Hospitals. Automated percutaneous lumbar discectomy (APLD) has been reported to have good clinical outcomes with low complication rates; however, the clinical efficacy of APLD performed in young male soldiers is uncertain. In order to clarify the efficacy of APLD for the treatment of LDH in young male soldiers, we designed a retrospective case-control study to compare patients who received APLD with patients treated with epidural steroid injection (ESI) alone.A total of 181 patients were enrolled and divided into the APLD (n = 92) and ESI (n = 89) groups according to the treatment modality. A simple logistic regression analysis was conducted to clarify the difference between the two. To optimize patient selection, APLD group was additionally divided for subgroup analysis into favorable (n = 59) and unfavorable (n = 33) groups based on satisfaction scales. A simple logistic analysis was also performed.The differences between pre- and postoperative numerical rating scale of pain (P = .0027) and hospital-own satisfaction scale (P = .0045) of the APLD group were significantly better compared to those of the ESI group. In terms of subgroup analysis, single-level pathology (P = 0.244) and protruded disc (P = .0443) were associated with favorable outcomes, whereas dual pathology and extruded disc were related with unfavorable outcomes.APLD using Dekompressor, performed in young male soldiers with back and radicular pain owing to LDH, showed better clinical outcomes compared to the ESI only therapy. Additionally, a single-level pathology with protruded disc was associated with favorable outcomes and may be indicated for treatment.

Utility of the Lateral Base Dural Tacking Method in Cord Tumor Surgery Performed Using Unilateral Hemilaminectomy: A Comparison of Dural Window Widths.

OBJECTIVE: Unilateral hemilaminectomy, which is used to remove spinal cord tumors, is simpler than laminoplastic laminotomy and affords certain biomechanical advantages. However, both incomplete tumor removal and inadvertent infliction of spinal cord damage attributable to the narrow surgical corridor remain of concern. When a spinal cord tumor is to be removed, it is important to ensure that the dural window along the surgical corridor is of adequate width. This study aimed to determine that the utility of lateral base dural tacking (LBT) method when cord tumor surgery is performed using a unilateral hemilaminectomy-a comparison of dural window widths with a traditional dural tack-up and a suspending-out (DSO) method with the aid of digital image-analysis software. METHODS: Twenty-one consecutive patients who had intradural-extramedullary spinal cord tumors removed using a unilateral hemilaminectomy were included in the study and analyzed retrospectively. We acquired DSO and LBT dural window images using surgical microscopes under identical conditions in consecutive order and then removed the tumors using the LBT method. We used digital image-analysis software to analyze the images quantitatively. The pixel numbers of LBT and DSO window were compared using a paired t test. RESULTS: Twenty-one tumorous lesions were successfully removed without any major problems using a unilateral hemilaminectomy through LBT windows. The mean pixel numbers of the LBT and DSO windows were 126,787 ± 41,938 and 85,940 ± 21,638. The LBT windows were 46% larger than the DSO windows (P < 0.001). CONCLUSIONS: We objectively proved that the utility of the LBT method for widening the surgical corridor created during hemilaminectomy.

Anatomical study of C-shaped canals in mandibular second molars by analysis of computed tomography.

The aim of this study was to investigate the prevalence and configuration of the C-shaped canal using serial axial computed tomography images of the mandibular second molars that had not been restored severely or treated endodontically, and to compare the thickness of the remaining tooth structure from the center of the canal to the outer surface of the deepest groove area in C-shaped mandibular second molar to that of "danger zone of perforation" in normal mandibular second molar. This distance was measured at the cervical, middle, and apical third level each. From 220 teeth, C-shaped canals were found in 98 teeth (44.5%). Almost all the grooves were directed lingual (99%). The continuous C-shaped canal was the most frequently found (49%) and the separated canal was the least (17.4%). The thinnest remaining tooth structure in the groove area of the C-shaped mandibular second molar was not different from that of the danger zone of normal mandibular second molar at the three levels (p > 0.05).

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage.

OBJECTIVE: Although twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option. METHODS: CSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed. RESULTS: Of the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC. CONCLUSION: When the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.

Surgical Resection of Non-Glial Tumors in the Motor Cortex.

BACKGROUND: Direct surgery to resect tumors in the motor cortex could improve neurological symptoms or cause novel motor weakness. The present study describes the neurological outcomes of patients after the surgical resection of non-glial tumors in the primary motor cortex. METHODS: The present study included 25 patients who had pathologically confirmed non-glial tumors in the motor cortex for which they underwent surgery. Tumor location was verified using anatomical landmarks on preoperative magnetic resonance imaging scans. All surgeries involved a craniotomy and tumor resection, especially use of the sulcal dissecting approach for intra-axial tumors. RESULTS: Of the 25 patients, 10 exhibited metastasis, 13 had a meningioma, and 2 had a cavernous malformation. Motor weakness and seizures were the most common symptoms, while 3 patients experienced only a headache. The tumor size was less than 20 mm in 4 patients, 20-40 mm in 14, and greater than 40 mm in seven. Of the 25 patients, 13 exhibited motor weakness prior to the operation, but most of these symptoms (76.9%) improved following surgery. On the other hand, eight patients experienced seizures prior to the surgery, and in three of these patients (37.5%), the seizures were not controlled after the surgery. In terms of surgical complications, a postoperative hematoma developed in one of the meningioma patients, and the patient's hemiparesis was aggravated. CONCLUSION: The present findings show that careful and meticulous resection of non-glial tumors in the motor cortex can improve preoperative neurological signs, but it cannot completely control seizure activity.

Perfusion Study for Internal Carotid Artery Trapping of a Traumatic Pseudoaneurysm in an Unconscious Patient.

Perfusion study should be preoperatively required for the trapping of an internal carotid artery (ICA) in the traumatic pseudoaneurysm in the petrous ICA. A 23-year-old man was admitted with a semicomatose consciousness after a passenger traffic accident. A fracture on the right petrous apex and a pseudoaneurysm in the right petrous ICA was found in the brain computed tomography (CT) angiogram. The size of aneurysm grew in the catheter angiogram at the 3rd day of trauma. One-day protocol of brain single photon emission CT (SPECT), which the first scan with 20 mCi of technetium-99m-ethyl cysteinate diethylester ((99m)Tc-ECD) and the second scan with 40 mCi in double dose at 15 minutes during the balloon test occlusion (BTO) at the same day, was done for the perfusion evaluation before trapping the right ICA. Perfusion asymmetry was aggravated of 21% at the post-occlusion scan in the right frontal cortex. So, he got a superficial temporal artery-middle cerebral artery anastomosis and then ICA trapping. After the surgery, he recovered consciousness and went back to his normal life. He has not developed new neurologic symptom for 8 years. Brain SPECT with double-dose injection of (99m)Tc-ECD may be a useful tool to be performed with BTO.

ACE Reduces Metabolic Abnormalities in a High-Fat Diet Mouse Model.

The medicinal plants Artemisia iwayomogi (A. iwayomogi) and Curcuma longa (C. longa) radix have been used to treat metabolic abnormalities in traditional Korean medicine and traditional Chinese medicine (TKM and TCM). In this study we evaluated the effect of the water extract of a mixture of A. iwayomogi and C. longa (ACE) on high-fat diet-induced metabolic syndrome in a mouse model. Four groups of C57BL/6N male mice (except for the naive group) were fed a high-fat diet freely for 10 weeks. Among these, three groups (except the control group) were administered a high-fat diet supplemented with ACE (100 or 200 mg/kg) or curcumin (50 mg/kg). Body weight, accumulation of adipose tissues in abdomen and size of adipocytes, serum lipid profiles, hepatic steatosis, and oxidative stress markers were analyzed. ACE significantly reduced the body and peritoneal adipose tissue weights, serum lipid profiles (total cholesterol and triglycerides), glucose levels, hepatic lipid accumulation, and oxidative stress markers. ACE normalized lipid synthesis-associated gene expressions (peroxisome proliferator-activated receptor gamma, PPARγ; fatty acid synthase, FAS; sterol regulatory element-binding transcription factor-1c, SREBP-1c; and peroxisome proliferator-activated receptor alpha, PPARα). The results from this study suggest that ACE has the pharmaceutical potential reducing the metabolic abnormalities in an animal model.